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A new OTC constipation treatment 
that takes water where it's needed 

Dulcobalance® is a new product from the makers of Dulcolax®. 
It dissolves in a glass of water then directs it to the bowel, 
where it works only on the stool. Dulcobalance®, which 
contains macrogol, is not absorbed into the body but uses 
natural osmosis to bind water directly with the stool. Plus, 
its specific mode of action limits bloating and flatulence. 12 
Dulcobalance® does not thicken in the glass and has a 
pleasant fruit flavour. As it contains no electrolytes, it is 
suitable for people with cardiovascular or kidney problems. 


macrogol 4000 
10g powder 

Gentle and effective relief 
from constipation 

• Hydrating action 

■ Promotes your natural rhythrr 
» Dissolves in water 

■ Flavoured with fruit juice 

ody-Friendly Solution for Constipation 

Dulcobalance® Product Information Presentation: Dulcobalance containing 1 0g of macrogol 4000 
in a sachet. Dulcobalance containing lOg of macrogol 4000 in a sachet. Indication: Symptomatic 
treatment of constipation in adults and children aged 8 years and above. Dosage: 1 to 2 sachets 
dissolved in water per day, preferably taken as a single dose in the morning. In children treatment should 
not exceed 3 months. Contraindications: Severe inflammatory bowel disease (e.g. ulcerative colitis, 
Crohn's disease), oi toxic megacolon associated with symptomatic stenosis, digestive perforation or 
risk of digestive perforation, ileus or suspicion of intestinal obstruction, painful abdominal syndromes of 
indeterminate cause, hypersensitivity to macrogol or any of the excipients. Warnings and precautions: 
Patients with hereditary pioblems of fructose intolerance should not take Dulcobalance. In case of 
diarrhoea, caution should be exercised in patients who are prone to a disturbance of water electrolyte 
balance (e.g. the elderly, patients with impaired hepatic or renal function or patients taking diuretics). 

Pregnancy and lactation: No data is available in pregnant women, therefore caution should be 
exercised when taking Dulcobalance during pregnancy. As macrogol is not significantly absorbed, 
Dulcobalance may be taken during lactation. Adverse effects: Common: abdominal distension and 
pain, nausea, diarrhoea. Uncommon: vomiting, urgency to defaecate, faecal incontinence and bloating. 
Very rare: Hypersensitivity reactions including pruritus, urticaria, rash, face oedema, Quincke oedema 
ana an isolated case or anaphylactic shock. Unknown: Diarrhoea leading to electrolyte disorders 
(hyponatremia, hypokalaemia) and dehydration. RRP (ex VAT): £4.88, 10 sachets Legal category: 
P Product Licence Number: PL 00015/0318 Product Licence Holder: Boehringer Ingelheim Ltd, 
Ellesfield Avenue, Bracknell, Berkshire RG12 8YS. Date of revision: November 2009. 
References: 1 . DiPalma JA et al. Overnight Efficacy of Polyethylene Glycol Laxative. Am J Gastroenterol 
2002; 97 1776-9. 2. Data on file. 

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No news is good news. Like so many 
cliches, this well-known phrase is 
frequently true - and so is the 
reverse. Good news is all too often 
no news, so much so that those of us 
who trade in news are at constant 
risk of becoming jaded cynics. 

So it is a great pleasure this week 
to be able to announce the 
prestigious shortlist for the C+D 
Awards 2010 (p22). 

It's certainly good news for our 
finalists - all 69 of them. Previous 
C+D Awards winners have 
repeatedly testified to the value of 
being recognised: from a self- 
confidence boost to team 
motivation; and from raised profiles 
within local communities to respect 
from PCTs, peers and other 
healthcare professionals. 

The other big announcement this 
week was, of course, the dissolution 
of parliament - after 13 years of 
Labour primacy, the countdown to 
the most-hyped general election in 
recent memory has well and truly 
begun. And in the latest of C+D's 
exclusive interviews with the big 
three's respective health chiefs, the 
Lib Dems have pledged to make 
community pharmacy a central 
plank of its plans to shake up the 
health service (p4). 

But whichever party is first past 
the post, it will have no choice but to 
face the increasing strain on the 
public purse and make its promised 
NHS overhauls in the context of 
budget cuts. So, however many 
soothing words politicians use to 

woo us in the race to the polling 
booths, there is no doubt that 
community pharmacy will have to 
prove its worth for every penny 

The sector is hoping that the 
ongoing cost of service inquiry will 
make the case for the true cost of 
providing an NHS pharmacy service. 
But as Hampshire & loW LPC chief 
officer Mike Holden reiterates (plO), 
community needs to provide more 
evidence of its effectiveness. 

So as well as being good news 
for the finalists themselves, the 
breadth of pioneering community 
pharmacy practice revealed in the 
C+D Awards 2010 shortlist is also 
good news for the sector as a 
whole. An incoming government 
could do a lot worse than to cast its 
eye over this showcase for evidence 
of what pharmacy is already 
achieving - and a taste of what more 
it could contribute to improving the 
nation's health if it was given more 
robust support. 

The C+D Awards 2010 shortlist 
proves that, all over the UK, 
community pharmacy is living up to 
its promise - we will have to wait to 
see if politicians can live up to theirs. 

It only remains for me to wish, on 
behalf of C+D, all our finalists the 
very best of luck for the final judging 
and announcement of the overall 
winners of the 14 C+D Awards 2010 
trophies - watch this space. 

Jennifer Richardson 
Features Editor 

4 Dispensing error guidelines imminent 

5 Script sorting changes slammed 

6 Avicenna plans to build own chain 
8 Locum warned over supply error 

10 Tk ur meds - text to improve compliance? 
12 Product and market news 
14 Xrayserand Duncan Rudkin 
25 Classified 
30 Postscript 

17 Update: motor neurone disease 

How to help patients manage their symptoms 

19 Practical Approach 

Must foreign pharmacists be proficient in English? 

20 Jobs for the girls 

How women can make it to the top in pharmacy 

22 C+D Awards 2010 -the shortlist 

Check out the 69 finalists 

24 Maximising OTC sales 

A seven-step refresher from Trevor Core 

26 Careers 

© UBM Medica, Chemist+Druggist incorporating Retail Chemist. Pharmacy Update and Beauty Counter Published Saturdays by UBM Medica, Ludgate House, 245 Blackfnars Road, London SET 9UY C + D online at: Subscriptions: With C + D Monthly pricelist £250 (UK), without pncelist £205 (UK). ROW price £365 Circulation and subscription: UBM Information Ltd, Tower House, Sovereign Park, Lathkill St, 
Market Harborough, Leics. LE16 9EF. Telephone: 01858 438809 Fax: 01858 434958 Refunds on cancelled subscriptions will only be provided at the publisher's discretion, unless specifically guaranteed within the terms of 
subscription offer. The editorial photos used are courtesy of the suppliers whose products they feature We are not responsible for the content of any external websites referred to in this magazine All rights reserved No part of 
this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopying, recording or any information storage or retrieval system without the express prior written consent 
of the publisher The contents of Chemist + Druggist are subject to reproduction in information storage and retrieval systems UBM Information Ltd may pass suitable reader addresses to other relevant suppliers If you do not wish 
to receive sales information from other companies please write to Emily Miles at UBM Medica Origination by ITM Publishing Services, Central House, 142 Central St, London EC1V 8AR. Printed by Headley Brothers Ltd. The Invicta 
Press, Queens Road, Ashford TN24 8HH Registered at the Post Office as a Newspaper Volume 273 No 6742 



Pharmacy minister: dispensing 
error guidelines due this month 

EXCLUSIVE Long-awaited CPS guidelines lifting threat of single error prosecutions expected 

Mike O'Brien: ensuring pharmacists aren't criminalised is key to government's plan 

Lib Dems: star role for 
sector in NHS vision 

The Liberal Democrats have vowed 
to put pharmacists at the vanguard 
of an NHS geared towards 
preventing killer diseases, following 
a general election triumph. 

The shift would be supported by a 
major shake up at PCT level, 
Norman Lamb, Lib Dem health 
secretary, exclusively told C+D. 

Funding for local commissioners 
could be decided by how well 
pharmacies and other NHS 
stakeholders were commissioned to 
improve public health, he said. 

This could be achieved through a 
QOF linked to the pharmacy contract, 
the Lib Dem health chief added. 

Mr Lamb said: "The network of 

community pharmacies has a really 
important role to play in screening 
and awareness about a host of health 
issues like smoking and obesity." 

He added: "At the moment PCTs 
stand passively by as NHS money is 
diverted to other areas. Instead you 
could incentivise them to use the 
forces available, including 
pharmacies, to make it happen." 

Under the Lib Dems, PCTs would 
be rebranded as local health boards 
with elected patient representatives 
deciding policy. Greater primary care 
spending would be financed by 
wholesale cuts on government 
quangos, Mr Lamb said, and by 
slimming down regulation. MG 

Chris Chapman 

Pharmacists could be free from the 
threat of prosecution for single 
dispensing errors from this month, 
the pharmacy minister has revealed. 

Speaking exclusively to C+D, Mike 
O'Brien said Crown Prosecution 
Service (CPS) guidelines on dealing 
with pharmacists making single 
errors would be published 
"hopefully within the next few 
weeks, within April". 

The guidance had been due early 
this year and its publication follows 
criticism from the RPSGB and 
shadow health minister Mark 
Simmonds over delays on the issue. 

Mr O'Brien said he was still 
"concerned" pharmacists could be 
given jail terms for single dispensing 
errors. And ensuring pharmacists 
"won't be criminalised" for single 
errors was a key part of government's 
plan for the sector, he added. 

A spokesperson for the DH 
confirmed the MHRA, DH and CPS 
had been working together to ensure 
dispensing errors were dealt with "in 
a proportionate way", and that the 
guidance was due for release in April. 

RPSGB president Steve Churton 
said the Society was continuing "to 
press for swift and decisive action" 
from the CPS, and growing 
"increasingly frustrated and 
impatient" with the delay. 

The CPS has come under 
increased pressure to decriminalise 
dispensing errors recently, following 
the announcement that locum 
Elizabeth Lee will appeal her criminal 
conviction for a single dispensing 
error later this year. 

Last month the CPS told C+D that 
guidelines for prosecutors to show 
leniency if pharmacists made a 
mistake were "still being considered" 
by the director of public 
prosecutions, and would "take as 
long as it takes" to be finalised. 

RPSGB ups payments 
on £12m pension deficit 

The RPSGB is set to increase by 85 
per cent its monthly deficit 
reduction payments to its final 
salary pension scheme. 

The Society will pay an extra 
£67,400 a month effective from 
January 2010, on top of the monthly 
£79,600 it already contributes to 
deal with a scheme deficit valued at 
over £12 million. 

Following RPSGB Council 
agreement last week, this interim 
measure will continue until a new 
deficit valuation is formalised with 
the scheme trustee, who requested 
the extra payment. 

In a Council paper proposing the 
additional payment, Society director 
of commercial services and 
resources Bernard Kelly said: "The 
deficit of the pension scheme is a 
liability of the Society, which cannot 
be removed and has to be dealt with 
in the long term. 

"Contributions made now... 
should not be regarded as money 
lost but as a reduction in the liability 

which will reduce the burden in 
future years." 

The deficit was valued at over 
£12.2m at the end of 2008, Mr Kelly | 
explained, after the trustee brought 
the valuation forward from the 
following December due to concerns 
over the impact of the RPSGB split. 

But the Society had argued the 
2008 valuation was "not justified" 
because of economic instability, he 
said, and that a 2009 valuation 
would give greater clarity on the 
impact of the split. 

The trustee had therefore agreed 
not to formalise the 2008 valuation j 
if the extra interim payments were 
be made until the 2009 valuation 
was finalised. 

A Society spokesperson confirmed 
Council had approved the additional I 
payments and said minutes of the 
meeting would be available shortly. I 

The deficit reduction payments 
are in addition to the Society's future! 
service contribution to the pension 
scheme. JR 

Watch C+D news editoi 
Gosney interview Liber 
Democrat health secrel 
Norman Lamb 


Watch out for video interviews with shadow health ministers at 

Script sorting changes 
slammed by contractors 

'Archaic sorting process' means more bureacracy, say pharmacists 

Zoe Smeaton 

Pharmacists have expressed concern 
about the additional workload that 
changes to prescription sorting 
requirements will bring, calling the 
changes "archaic" and "ridiculous". 

The changes revealed by NHS 
Prescription Services will mean 
pharmacies have to separately sort 
prescription forms containing 

'specials' or individual items with a 
net ingredient cost of £100 or more. 
Broken bulk items will also be sorted 
in this way, as before. 

The moves are designed to reduce 
errors in pricing by the automated 
system and to safeguard 
contractors' monthly payments by 
allowing increased attention to be 
paid to these items. 

But pharmacists said the moves 
brought yet more bureaucracy. 

Anger at 'questioning of professionalism' 

Pharmacists have expressed anger 
as some manufacturers continue to 
request faxed proof of demand 
before despatching medicines in 
short supply. 

The requests for faxed 
prescriptions come despite 
agreements at the recent stock 
shortages summit for stakeholders 
to work together to ensure patients 
get medicines. 

Keith Sykes, of Newington 
Pharmacy, Hull, told C+D: "I am 

Society 100- 
day deadline 

Ambitious development targets set 
by the RPSGB's new professional 
leadership body in January are 
still to be met as the 100-day 
deadline for completion of the 
goals draws near. 

So far just one of the seven 
overarching commitments to 
members has been fulfilled, 
although three more have been 
partially completed as the April 19 
deadline approaches. 

The Society said it would release 
an update on the pledges, which 
include improving awareness and 
perceptions of pharmacy and 
actively listening and responding to 
members, on April 24. 

George Romanes, of the Romanes 
Pharmacy Group, said: "They have 
made a pretty good stab at it 
considering what they have to do in 
100 days." MH 

annoyed at the stance taken by 
Novartis that requires me to fax 
copies of prescriptions. It takes up 
valuable time and calls into 
question my professionalism." 

PSNC agreed the procedure was 
burdensome and other leading 
manufacturers said they had no 
such policy. 

Novartis said copies of 
anonymised scripts helped them 
check orders related to patients 
needing immediate supply. 

Graham Phillips of the Manor 
Pharmacy Group in Hertfordshire 
criticised the "evermore archaic 
sorting processes". He said the 
government needed to "do 
something about this absurd 
bureaucracy and their inability to do 
simple things like price prescriptions". 

However, other contractors 
expressed relief that the changes 
might improve pricing accuracy at 
least. Lila Thakerar, of Shaftesbury 
Pharmacy in Harrow, said she had 
decided to sort specials separately 
anyway recently after seeing many 
incorrectly priced. In some cases she 
had been reimbursed in the region of 
£1 for items worth over £300. She 
said the changes would help 
pharmacies who might not be aware 
they were being underpaid. 

Janet Edginton, PSNC's head of 
pharmacy audit, said sorting items 
over £100 would "clearly require 
additional pricing knowledge by the 
pharmacy staff" but that the 
committee would produce a list of 
commonly prescribed items over 
£100 to help pharmacies adapt. 

Chemist+Druggist has announced the shortlist for the C+D Awards 2010, in 
association with the NPA. From what the judges described as "a really excellent 
batch of applications", 69 pharmacists, pre-registration graduates, technicians, 
assistants and others made it onto the prestigious shortlist for the third annual 
C+D Awards. "We were delighted by the record number of entries to the C+D 
Awards 2010," said C+D editor Gary Paragpuri. "They were of an incredibly high 
quality and it was wonderful to see such a diverse range of entrants, including 
LPCs and PCTs." The finalists will now be invited to join colleagues and community 
pharmacy leaders at an awards ceremony in June, when the winners of the 14 
trophies will be revealed. To see who made it onto the shortlist, turn to page 22. 

Cyklo-F approved 

The first OTC medicine to treat 
heavy menstrual bleeding has 
been approved by the MHRA. 
Meda Pharmaceuticals plans to 
launch the product under the 
brand name Cyklo-F in early 2011 
as a P product containing SOOmg 
tranexamic acid. 

NPA slams proposals 

The NPA has spoken out against 
DH proposals to implement 
generic substitution in 
pharmacies, saying the changes 
are counter to the drive for quality 
in health services and less likely to 
achieve financial savings than 
measures to reduce waste. 

Herbal regulation 

Pharmacists could have to register 
with the Complementary and 
Natural Healthcare Council if they 
wish to continue supplying 
unlicensed herbal and other 
complementary medicines in the 
future, following an announcement 
by health secretary Andy Burnham. 

Services boost custom 

Additional services such as MURs, 
smoking cessation and emergency 
contraception could be responsible 
for increased customer numbers 
in pharmacy stores, according to a 
GSK survey. Fifty three per cent of 
pharmacists whose stores offered 
the services had seen a rise in 
footfall and 22 per cent of those 
saw improved retail sales. 

GP guide published 

Guides for pharmacists and GPs to 
help them develop more effective 
working relationships between the 
two professions have been 
published by PSNC, the British 
Medical Association's General 
Practitioners Committee and NHS 

Overseas masters 

The School of Pharmacy and Life 
Sciences at Robert Gordon 
University, Aberdeen, is the first 
UK institution to offer a masters 
course allowing internationally 
qualified pharmacists to apply for 
UK pharmacy pre-reg training 
schemes. 5 


Read C+D reporter Chris Chapman's Avicenna conference blog 

As the pharmacy 
white paper marks its 
second birthday, how 
well has it been 

"The white paper has been a missed 
opportunity for pharmacy. What 
started out with the best of 
intentions has been woefully 
underfunded by government." 
Graham Jones, Broadway 
Pharmacy, Hungerford, Berkshire 

"Not at all. The potential is there and 
the theory is good but there seems 
to be no emphasis on it from local 
PCTs, which is where the money for 
it is coming from." 
Geoff Ray, Total Health 
Pharmacy, Watton, Norfolk 

Exceeded expectation 0"V„ 

Delivery on target A 

Behind in areas 55% 

delivered 45% 

Armchair view: It's a damning 
verdict for those charged with 
delivering the white paper, as not a 
single voter thought implementation 
targets were being met. 
Next week's question: 
Could text message reminders help 
patients take medicines properly? 
Vote at 

Avicenna set to form 
chain in London area 

EXCLUSIVE Purchase of significant number of pharmacies 'imminent' 

Chris Chapman 

c hris. 

Independent pharmacy group 
Avicenna is set to become a multiple 
pharmacy chain "imminently" by 
acquiring premises in the London 
area, C+D can reveal. 

The group is looking to form its 
own retail chain following continued 
growth, which saw an operating 
profit of £1.5 million last year and 
membership expand to 1,250 
members, chairman David Gration 
told the Avicenna Conference in 
Kerala on Tuesday. 

Speaking afterwards to C+D, Mr 
Gration revealed the move to 
acquire pharmacies for the chain 
would be "imminent", and said he 
expected "a significant number" 
to be purchased for the company. 
"You can see the ambition of the 
company is big - it's not going to be 
just one," he said. 

Avicenna director Uma Patel told 
C+D the number of pharmacies 
acquired would depend on price, and 
he declined to be drawn on a 
timeline. However, he added that 
the group had the financial reserves 
to make a significant purchase. "If a 

Uma Patel: "If a chain of 20 comes up 
at the right price, we'll buy." 

chain of 20 comes up at the right 
price, we'll buy... we certainly have 
the firepower," he said. 

When asked about potential 
locations for the chain, Mr Patel said 
the pharmacies were likely to be in 
London or the surrounding area. He 
said: "A good quartermaster says 
you should keep your line of 
communication short... within the 
M25 or a commutable distance." 

Proposals may ease foreign 
pharmacist restrictions 

Community pharmacy 
representatives have backed 
proposals that could make it easier 
for the sector to take on foreign 

The NPA, CCA and Day Lewis all 
welcomed an independent body's 
recommendation that the 
government reinstate community 
pharmacists to its shortage 
occupation lists. 

If the Home Office accepts the 
Migration Advisory Committee's 
(MAC's) suggestion, the sector will 
once again be able to freely recruit 
migrant workers from outside the 
European Economic Area (EEA). 

Day Lewis head of HR Stephen 
Wellings called the MAC's 
recommendation "a victory for 
common sense". 

But the Home Office decision will 

now have to wait until after the 
General Election, following the 
dissolution of parliament this week. 

The NPA said it hoped the 
incoming government would 
recognise the increased demand for 
community pharmacists due to 
rising pharmacy numbers, longer 
opening hours and new services. 

NPA head of external affairs 
Stephen Fishwick said: "Community 
pharmacy is taking on an ambitious 
change programme and needs the 
government to take a suitably long 
term view on workforce." 

Pharmacy bodies slammed the 
removal of community pharmacists 
from the shortage occupations list 
last summer (C+D, August 1, 2009, 
p8), when some students were left 
unable to take up pre-reg 
placements. JR 

Virtual chain 
roll out 

Avicenna is already piloting its 
ACE Plus 'virtual chain' concep 
providing head office function: 
for independent pharmacies, a 
will roll it out from July, CEO 
Salim Jetha has said. 

The group said the future of 
the independent sector lay in 
banding together to form virtui 
chains that could cut down 
paperwork by providing 
centralised head office support. 

PSNC chief executive Sue 
Sharpe agreed that such 
developments were critical to 
the survival of the independen 

Speaking exclusively to C+D, 
Mr Jetha said the ACE Plus 
service had been piloted in more 
than 40 pharmacies, and that he 
hoped around 10 per cent of 
Avicenna's membership would 
sign up. 

"Trials have shown this is 
working, that the membership is 
happy," he said. 

switch halted 

Actavis has confirmed that it has 
withdrawn its application for its 
trimethoprim preparation Cysticlear 
to switch from POM to P, as press 
reports suggest MHRA moves to 
switch the drug have been stopped. 

The switch application, originally 
made in 2005, gained strong support 
from the pharmacy sector including 

However, the application to 
switch trimethoprim from POM to P 
raised concerns about overuse of 
antibiotics and the risk that 
pharmacy customers would not 
follow treatment instructions. 

GP magazine Pulse reported this 
week that the government had 
stepped in to halt the switch. 

Actavis said it would be robust in 
pursuing its POM to P pipeline in 
other therapeutic areas. CMA 


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throughout April... 


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Enter the swine flu pandemic survey online 

Warning over supply error 

Locum dispensed 10 times required amount, RPSGB panel told 

A pharmacist from Holywell has 
been given a warning by an RPSGB 
disciplinary panel after supplying 
2,100 methadone 5mg tablets, 
which had been erroneously 
prescribed by a CP, to a patient. 

Working as a locum pharmacist 
at Runcorn Late Night Pharmacy, 
David Sheppard dispensed the full 
amount on or around July 6, 2006, 
for a patient who was going on 
holiday to Ireland for three weeks. 

The tablets amounted to 10 
times the methadone required for 
the holiday, or more than six 
months' worth, and are now 

believed to have been sold on the 
black market, the RPSGB panel heard. 

The disciplinary panel was told 
Mr Sheppard dispensed the amount 
"without checking it was correct". 
Mr Sheppard denied that he had 
failed to adhere to accepted 
standards, saying another 
pharmacist had checked the 
prescription and that he considered 
that was sufficient. 

But he was found guilty of failing 
to adhere to accepted standards in 
a way likely to bring the profession 
into disrepute or undermine public 
confidence in the profession. The 

disciplinary panel issued a warning 
that will remain on Mr Sheppard's 
record for five years. 

The panel said that, although the 
other pharmacist had checked the 
prescription, Mr Sheppard should 
also have done so. 

However, panel chair Patrick 
Milmo QC said this had been a 
"single, isolated incident in a long 
and unblemished career". 

He added that Mr Sheppard had 
made "good efforts to improve his 
practice" and was now a "highly 
scrupulous and conscientious 
practitioner". UKl 

C+D News Survey 

As the DH promises a review into the response to the 
swine flu pandemic, C+D asks how it was for you 

sales pick up 

The market for pharmacy business 
sales is picking up, but some 
analysts have warned obtaining 
funding for the deals is still 
slowing progress. 

David Reissner, head of 
healthcare at Charles Russell, said 
the law firm had clients looking to 
get into pharmacy for the first 
time and he anticipated increased 
sales. Finance company Pharmacy 
Partners had seen more activity in 
pharmacy acquisitions recently, in 
particular from independents. 

But Umesh Modi, a pharmacy 
financial advisor at Silver Levene, 
warned difficulties getting loans 
were having an impact. 


an iPod Shuffle 

Return the survey by April 23 
and be entered into a draw to 
win an iPod Shuffle! 

1. Overall, how well was the swine flu 
response in your area organised? 

a) Very well organised 

b) Quite well organised 

c) Quite disorganised 

d) Very badly organised O 

2. How well did your PCT keep you informed 
and updated throughout the pandemic? 

a) Very well, with direct communications 

b) Quite well □ 

c) Poorly □ 

d) It didn't communicate with us directly C3 

3. How well did your LPC liaise with the PCT 
during the pandemic? 

a) Excellently L"") 

b) Reasonably well D" 

c) Adequately G 

d) Poorly □ 

Your name: 

4. How badly were patient services disrupted 
at your pharmacy during the pandemic? 

a) Seriously disrupted J 

b) Affected, but not seriously O 

c) We had to work harder, but they weren't 

d) No disruption to us or to services □ 
How were they affected? 

5. Were you and your staff offered swine flu 

a) Yes □ 

b) No □ 

If yes, did you choose to have it and why? 

6. What changes could have improved 
pharmacy's response to the pandemic? 

a) More communication to pharmacy O 

b) A national response plan for pharmacy CJ 

c) Other, please state 

7. Have you made changes to prepare for a 
future pandemic, eg creating a pandemic 


a) Yes □ 

b) No □ 

If yes, what changes have you made? 

You can also enter the survey online at Enter by 
April 23 for a chance to win an iPod Shuffle. 

Job title: 


rj dress 


Email address: 

Daytime phone number: 

Post this completed page to: C+D, 8th Floor, Ludgate House, 245 Blackfriars Road, London SE1 9UY or fax it to 0207 921 8132. 
All complete entries returned by April 23 will be put into a draw for the iPod Shuffle 

UBM Medica would like to keep you up to date about our products and services for healthcare You can view our privacy policy at 
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- 1 >-i 


1 "-A^^^^ 

--! 1 








Have any of your patients told you that pain crawls over their skin? Chronic pain that is hard to 
treat can become frustrating. You can aid your patients by asking them to describe their pain, 
which will help you to identify those with neuropathic pain. 




Action on 




Trigeminal Neuralgia 
Association UK 


The Charity for Healthier Backs / ,. 




Brought to 
you by 

06-00143A2a | © Pfizer Limited 2009 All rights reserved. | Date of preparation. July 2009 





Read the latest news online 

1 0.04.1 mvw.chemistanddnigglstcauk 

Text messages latest weapon in 
battle for medicines adherence 

As improving compliance remains a key target for the NHS and pharmacy, Zoe Smeaton finds 
out how an IT system house has shown texting patients might be the next step 

Message Dynamics: how Cegedim Rx's 
repeat prescription service works 

30 seconds 

call length to remind patients their repeat is due 

per month cost 
per 1 00 patients 


records analysed 

increase in dispensing 
of required medicines seen 

With its promises to help save the 
NHS money and boost patient 
wellbeing, improving medicines 
adherence is rightly high on the 
health agenda. And although an IT 
system house might not be the most 
likely place to look for inspiration on 
the matter, Cegedim Rx thinks it has 
provided just that with a recent 
university study. 

The study focused on the system 
house's Message Dynamics service, 
which sends a text or calls patients 
when their repeat prescription is due. 
Patients are reminded when their 
repeat prescription is due and asked 
if they would like it to be requested 
for them. 

The study, by the University of 
Surrey, analysed over 10,000 
anonymous prescription records 
from 217 patients, comparing 
compliance in collecting prescriptions 
when they were needed before and 
after patients started using the 
messaging service. The researcher 
concluded the messages significantly 
improved patient compliance: the 
numbers of treatment days 
dispensed to previously under- 
compliant patients rose, while those 
dispensed to previously over- 
compliant patients were reduced. 

The study found that on average 
pharmacies saw a 14 per cent 
increase in dispensing to the patients 
- welcome news for any struggling 

If patients do not need their 
repeat, they are asked to leave a 
message, which the pharmacist can 
listen to at any time, explaining why 
they do not want it. This could 

enable pharmacists to provide 

Simon Driver, Cegedim's 
managing director, says he believes 
the research shows pharmacists can 
help boost medicines adherence, as 
getting the medicine into patients' 
houses at the right time must be a 
first step in compliance. "Give 
people the right medicine at the 
right time... it's such an obvious 
thing," he says. Experts agree this 
could be the case, although they 
caution that the service would not 
solve adherence problems on its own. 

C+D understands DH research 
into why patients don't take their 
medicines is undergoing scrutiny. 

But, even without this study, it is 
clear that for at least some patients, 
forgetting about their medicines is a 
factor in non-compliance. 

Alastair Buxton, head of NHS 
services at PSNC, says for some 
patients there is an issue around not 
collecting their prescriptions 
correctly. While improving this 
would be useful, he cautions: "There 
are even more complex issues with 
people who collect them but still, for 
a myriad of reasons, don't take them." 

Professor David Taylor of the 
School of Pharmacy, University of 
London, also agrees there is 
"something to be said" for Mr 
Driver's argument that the 

messaging service can boost 
compliance, although he questions 
whether it would be more useful to 
intervene specifically at the 
beginning of treatment regimes. 

The text messaging service could 
logically go one step further and 
remind patients by text to actually 
take their medicines. But Mr Buxton 
says this might still not be enough to 
convince those patients who don't 
take their medicines for complex 
psychological reasons. 

Despite some limitations, Mr 
Driver says he hopes the research 
could be used to help negotiate 
services for pharmacy in this area, by 
demonstrating the sector can have 
an impact. "If you've got these 
adherence problems and hospital 
admissions, to me the obvious route 
for any government must be help 
pharmacists to manage medicines," 
he says. 

And experts are unanimous in 
their view that studies like this 
where data shows community 
pharmacy services are effective, are 
vital to secure such help. Mike 
Holden, chief officer of Hampshire & 
Isle of Wight LPC, says: "Sometimes 
commissioners have to go on blind 
faith that we can deliver a service. 
We need to create more evidence... 
it's very powerful." 

With studies such as Cegedim's 
happening more and more at a local 
level though, momentum to gather 
this evidence seems to be building. 
And with developments such as 
RPSCB guidance on advancing 
pharmacy research expected shortly, 
perhaps the only way to go is up. 


its medicines adherence top of agenda 

PSNC has said national services, 
such as those to slash medicines 
waste and improve patient 
adherence, will be the "main focus" 
in the coming months. 

Such services were essential to 
overcome "very poor" commissioning 
in some areas, PSNC chief executive 
Sue Sharpe told the Avicenna 
Conference in Kerala this week. 

Mrs Sharpe hinted at progress on 
developing a service to help patients 
when they are first prescribed a 
medicine for a long-term condition. 
She said: "The ability for pharmacists 
to target waste of medicine is a key 
area for future development. I am 
very hopeful we will develop a new 
service, commissioned nationally, for 
that first prescription." 

But with the current mechanism 
of funding rewarding higher volumes, 
Mrs Sharpe told C+D it could be 
"really difficult" to develop a service 
to reduce waste. To do this, she said, 
funding would need a radical 
overhaul to shift away from volume 
and reward patient services. "We 
need to move away from the 
vulnerability we have over the 

number of pieces of paper a GP 
chooses to issue [governing 
funding]," she said. 

Mrs Sharpe added that 
developing adherence services and 
a new funding model that would 
pay pharmacists to make sure 
patients get the most out of their 
medicines would be a 'win-win' for 
the NHS. CC 


Welcome to a world of 

allergic rhinitis relief... 


fluticasone furoate 



Prescribing Information 

(Please refer to the full Summary of Product Characteristics before prescribing) 
Avamys'Y Nasal Spray Suspension (fluticasone furoate 27.5 micrograms /metered spray) Uses: 
Treatment of symptoms of allergic rhinitis in adults and children aged 6 years and over Dosage and 
Administration: For intranasal use only, AMts: Two sprays per nostril once daily (total daily dose, 110 
myograms). Once symptoms controlled, use maintenance dose ol one spray per nostril once daily (total daily 
dose, 55 micrograms). Reduce fo lowest dose al which effective control of symptoms is maintained. (Mien 
aged 6 fo )) years: One spray per nostril once daily (total daily dose. 55 micrograms) If patent is not 
adequately responding, increase dairy dose to 1 10 micrograms (to sprays per nostnl. once daily) and reduce 
back down to 55 microgram daily dose once control is achieved Contraindication: Hypersensitivity to active 
substance or exdpients Side Effects: Systemic effects of nasal corticosteroids may occur, particularly when 
prescribed at high doses lor prolonged periods Very common epistaxis Epistaxis was generally mild to 
moderate, with incidences in adults and adolescents higher in longer-term use (more than 6 weeks). Common 
nasal ulceraton. Rare: hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria. 
Precautions: Treatment with higher than recommended doses of nasal corticosteroids may result in clinically 
significant adrenal suppression. Consider additional systemic corticosteroid cover dunng periods of stress or 
elective surgery Caution when prescribing concurrently with other corticosteroids. Growth retardation has been 
reported in children receiving some nasal corticosteroids at licensed doses Monitor height of children 
Consider referring to a paediatnc specialist. May cause irritation of the nasal mucosa Caution when treating 
patients with severe liver disease, systemic exposure likely to be increased. Nasal and inhaled corticosteroids 
may result in the development of glaucoma andJor cataracts Close monitoring is warranted in patients with a 
change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts Pregnancy 

and Lactation: No adequate data available. Recommended nasal doses result in minimal systemic exposure. 
It is unknown if fluticasone furoate nasal spray is excreted in breast milk. Only use rf the expeded benefits to 
the mother outweigh the possible nsks to the foetus or child. Drug interactions: Caution is recommended 
when co-administenng with inhibitors of the cytochrome P450 3A4 system, e.g. ketoconazole and ritonavir. 
Presentation and Basic NHS cost: Avamys Nasal Spray Suspension. 120 sprays: £644 Marketing 
Authorisation Number: EU/1/07/434/003 Legal category: POM PL holder: Glaxo Group Ltd. i 
Last date of revision: January 2010 

Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to GlaxoSmithKline 
on 0800 221 441. 

Avamys' is a 

trademark of the GlaxoSmithKline group of companies. 


1. Fokkens WJ, Jogi R, Rernartz S el a/. Once daily fluticasone furoate nasal spray is effective in 
seasonal allergic rhinitis caused by grass pollen Allergy 2007. 62 1078-1084. 

2. Kaiser HB, Nacleno RM, Given J ef al Fluticasone furoate nasal spray, a single treatment option for 
the symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 2007. 1 19(6) 1430-1437 

3 Jacobs R Martin B Hampel F el s! E K e:'";er-;s c ; J :.5S"e HOyg jnce :a . " 
treatment of nasal and ocular symptoms ot seasonal allergic rhinitis in adults and adolescents 

sensitized to mountain cedar pollen. Cun IWed Res Opm 2009. 25(6) 1393-1401 
4, Vasar M, Houle R Douglass J el al Fluticasone furoate nasal spray effective monotherapy for 
symptoms of perennial allergic rhinitis in adults/adolescents Meigt Aslfima Proc 2008, 29 313-321 

5 Avamys Summary of Product Charactenstics 2010 

6 Berger WE, Godfrey JW, Slater AL Intranasal corticosteroids the development ol a drug delivery 
device for fluticasone furoate as a potential slep toward improved compliance. Expert Opm Drug DA 
2007: 4(6): 689-701. 

7 Berger W. Godfrey JW. Grant AC et al Fluticasone furoate (FF) nasal spray - development of a 
next-generation delivery system for allergic rhinfe. J Allergy Clin Immunol 2007, 119(1 Suppl) S231 

8. Godfrey JW, Granl AC, Slater AL. Fluticasone furoate (FF) nasal spray - ergonomic considerations 
for a next generation delivery system J Allergy Clin Immunol 2007, 1 19(1 Suppl) S230 

© GlaxoSmithKline group of companies 201 0. 

Code UKjFF7OOO8.n0 Date of preparation: February 2010 

Allen & HANBurrvs 


Check out what's on TV 

Actavis adds 
EC options 

Prednisolone ^ 


Actavis has extended its range of 
prednisolone EC tablets with larger 
pack sizes. 

The two strengths, 2.5mg and 
5mg, now come in two new pack 
sizes containing 30 and 100 tablets. 

Actavis says the wider range of 
pack sizes will provide dispensers 
with additional options, along with 
increased customer choice, 
depending on patient preference for 
a single dose or divided daily dosage. 

The range is available from all 
Accumulator wholesaler partners. 

See C+D Monthly 
Pricelist or 
Actavis UK 
Tel: 0800 373573 

Ny tol in TV 

Nytol will be on TV until April 2011 
in a £1 million sponsorship package 
with Sky's Gold TV and Watch TV. 
The brand will be on air every 
evening from Sunday to Thursday on 
Watch and every Sunday on Cold. 

CSK says the initiative is designed 
to create long-term exposure for 
Nytol on channels that reach the 
brand's target audience. 

The animated campaign has been 
developed by Wallace and Gromit 
creator Aardman Studios. It features 
Nytol character Joan who plays a 
scriptwriter, with different voiceovers 
to keep the campaign fresh. 

GILaxoSmithKline Consumer 


Tel: 0845 762 6637 

Bonjela has mouth ulcers covered 
with launch of new treatment 

Reckitt Benckiser has 
new treatment for 
mouth ulcers in its 
Bonjela range. 

Complete Plus is 
formulated to 
create a protective 
barrier to protect 
mouth ulcers for up 
to four hours, 
soothe pain and aid 
the healing process. 

The gel comes 
with a soft precision 
applicator designed 
for accurate and 

The applicator can 
back into the bottle a 

launched a 

for the next application with no 
need for rinsing or 
sterilising, according to 
Reckitt Benckiser. 

The company says 
the product can help 
treat minor ulcers but 
if an ulcer is causing 
significant pain 
or has lasted for more 
than three weeks, 
customers should see 
their G P. 

The product should 
not be used on ulcers 
larger than 1cm and is 
only suitable for use 
from 16 years. 

go directly Price and Pip code: 

fter use ready £7.99/1 0ml (100 applications), 

Market focus 

• Bonjela is the market leader 
in the £21.6 million adult 
mouth ulcer category with a 
45 per cent value share (AC 
Nielsen MAT February 2010). 

• Minor ulcers account for 80 
per cent of all mouth ulcers 
and are more common among 
women and people who are 
aged under 40 ( 

Reckitt Benckiser 
Tel: 01482 326151 

Spring makeover for Power Health supplements 

Power Health is introducing a 
fresh new look for its health 
food supplements this 

Power Health tablets 
and capsules will now be 
presented in eye-catching 
red pots with gold hinge 
guard (tamper evident) 
lids. Some powders in the 
range will also be 
supplied in the same 

Five new label styles help 
differentiate between the 
supplement categories across 
the range. 

Power Health is also relaunching 
Memory Lane, which is claimed 
to be a brain-boosting supplement 


horny go 



?0 ,,„ 

marketing campaign until June. 
In-store promotions are planned 
for later this year. 

that can enhance mental ability in 
three weeks, and Phytosterols, 
which has been formulated to help 
lower cholesterol. 

The new packaging will be 
supported with a national PR and 

Prices Memory Lane 
£17.99/30 capsules, 
Phytosterols £10.69/60 

Pip codes: See C+D Monthly 
Pricelist or 
Power Health Products 
Tel: 01759 302595 

Check out what's on TV 
this week 

Red Kooga springs into action 

Vifor Pharma (Potters Ltd) is 
supporting its Red Kooga ginseng 
brand with an advertising campaign 
in women's lifestyle magazines this 
spring. The campaign is targeted at 
busy women with hectic lifestyles. 

A second burst of women's 
magazine advertising is planned for 
September and October to coincide 
with the seasonal uplift in VMS 
sales. PR activity for the brand 
includes regional radio interviews 
with lifestyle coach Rebekah 

The new marketing drive follows 
the launch of four additions to the 

Red Kooga range earlier this year: 
Korean Ginseng capsules, Korean 
Ginseng with Multivitamins & 
Minerals, Korean Ginseng & 
Ginkgo Biloba and Natural Energy 
Release (previously known as Red 
Kooga Energise). 

A new consumer website for the 
brand - - has 
also been launched. 

Product deals for independent 
pharmacies are available from the 
Ceuta Healthcare salesforce. 

Price: from £2.99/10 tablets 
Natural Energy Release to 


1 -- --- I 

Ginseng ^ 

£9.49/32 tablets Ginseng and 
Cingko Biloba 

Pip codes: See C+D Monthly 
Pricelist or 
Ceuta Healthcare 
Tel: 01202 780558 



What do you think? 



to make new friends in high places 


It's not often that the pharmaceutical press 
resembles the daily tabloids, but the headline 
"Murky double life leads to three-year jail term" 
featured prominently last week. We've always 
sought a high profile for the profession, but I think 
the idea was for the 'face of pharmacy' to have the 
Rx Factor not the Sex Factor. Sadly, the many 
jokes doing the rounds about "the only pharmacist 
who hasn't got a drug supply problem is Charles 
Butler" belie the potential damage this man may 
have done. 

I don't mean to the 'image of the profession' - 
after all, pharmacists are not exactly known for 
being racy or exciting, and none of us expects a TV 
soap opera or a drama to be set in a pharmacy 
because it would be so bloody boring. Actually, 
having the odd libertine colleague allows me to 
suggest to mates in the pub that I don't spend 
every night in bed with just a cup of cocoa and 
my C+D. 

No, more important is the loss of a prominent 
and previously respected supporter at the heart of 
government - or at least as close as we have had 
to date. 

Why is that important? Well, which of these 
headlines do you prefer: "Pharmacy saves NHS 
£1.8bn" or "Pharmacy made £1.1bn excess profit"? 
Both of these statements are true, according to a 
National Audit Office report, and the DH has 
pledged to consider its recommendation that 

include reducing PSNC's role, and removing such 
retained profit that even the NAO admits it 
could threaten the viability of some pharmacies. 
Although "pledge to consider" really just means 
"we'll think about it" in Civil Service speak, the 
problem is the NHS is a world governed on the 
basis of executive summaries, and the spin placed 
on them. 

We all remember the expression: "It's not what 
you know but who you know", and if ever 
pharmacy needed friends in high places, it's now. 
Those friends can bring all your birthdays and 
Christmases in one - as the GPs found in their new 
contract - or such influence as brought the OFT to 
bring about the control of entry exemptions. 

So now is the time to make friends with 
parliamentary candidates, who are in the pre- 
election desperate stage. I recently contacted 
three of mine, and before you could say "photo 
opportunity" they were banging on the door. We 
have spent too long developing these political 
links, with the all-party pharmacy group, and 
C+D's own Building Bridges campaign with MPs, 
to throw it all away now. 

But, if the NAO persuades the DH that it's 
worth the loss of a few little backwater shops 
to cut the cost of pharmacy by a quarter, it could 
be a case of too little, too late, if we've failed 
to convince our elected representatives of our 
true value. 

Professionalism means doing the right thing 

What does professionalism mean to 
you? Someone told me once that 
professionalism is about doing the 
right thing when no one's looking. I 
like that idea. It captures the 
essential point that professionalism 
is not something imposed from 
outside - by regulators say - but a 
set of values that only have meaning 
if they come from within the 
individual, and the profession of 
which they are part. 

In that sense I'd argue that 
professionalism is the truest form of 
'self-regulation'. Professionalism 
goes to the heart of everything you 
do, including the way you behave, 
your code of ethics, the way you 
treat people. In short, it is an 
attitude of mind. So, where does the 
regulator come in? 

In the 21st century the professions 
are all faced with the need to maintain 
their relevance and standing against 
the background of a rapidly 
changing society. One definition of a 

profession is "a group of individuals 
with specialist knowledge and skills 
bound by a code of ethics working in 
tacit agreement with society where 
the relationship is one of trust 
between the public and the 
practitioner". This might be 
threatened as an increasingly diverse 
and less deferential society finds it 
harder than ever to give the tacit 
agreement which permits the 
. relationship to thrive. 

I firmly believe that this is where 
the 21st century regulator comes 
into its own. It is in the position of 
being able to offer independent 
assurance to the public. In 
supporting areas of unchanging 
professionalism - competence, 
integrity, honesty, altruism - and 
by providing a code of ethics that 
demonstrates accountability and 
openness whichever way it is viewed, 
the modern regulator can exercise 
independent judgement fundamental 
to building and maintaining 

public trust and confidence. 

This is not just about assuring 
minimum standards and dealing 
with problems, either. Lurid 
reporting of fitness to practise cases 
may grab the headlines, but 
regulation is just as much about 
helping to move standards forward 
and enabling responsible innovation 
as it is about professional discipline. 

The creation of the GPhC is part 
of a programme of reforms focused 
on trust, assurance and safety. The 
trust that patients and the public 
place in pharmacists and pharmacy 
technicians, and in pharmacies, 
can and should be underpinned 
by an independent assurance, from 
a body with no pharmacy or 
government axe to grind, about the 
safety and standards of the care and 
services on offer. That's good for 
patients and the public and, I'd 
argue, for the profession. 
Duncan Rudkin is chief executive 
and registrar of the GPhC 




One-stop accredited pharmacist training. 
MURs, public health, pharmacy 
management and near-patient testing at 
or phone 0207 921 8425. 



Update: motor 
neurone disease 

Helping your patients 
to manage their 

Practical Approach 

How well do you know 
the rules on English 
proficiency for foreign 

Jobs for the girls 

How female-friendly 
is pharmacy? We talk 
to women who made 
it to the top 

C+D Awards 2010 

It's been a tough job, 
say the judges, but a 
record level of entries 
is down to 69 finalists 

your OTC sales 

A seven-step refresher 
on the basics from 
Reckitt Benckiser's 
Trevor Gore 


As ethical objections to 
contraception services 
hit the news again, 
Chris Chapman 
unravels the rules 

T.COUK 15 


Accredited by 
the RPSGB 

Benchmark is an accredited training course for 
^^^^ dispensary assistants. 

Written by a team of experienced community 
pharmacists and medical writers, Benchmark 
has been mapped to both the Pharmacy 
Services S/NVQ2 and the Skills for Health 
framework that will supersede the NVQ later 
this year. 

Meets RPSGB requirements for 
dispensing assistants. 


aff, or to find out more 

425. Alternatively visit 

Need specific CPD resources? Check out our clinical index 



Your weekly CPD revision guide 

Motor neurone disease 

How pharmacists can help patients manage their symptoms 

60-second \y 

Motor neurone disease is a cruel 
condition; life expectancy is generally 
two to five years, and patients can die 
within six months of MND symptoms 
appearing. There is no cure. This article, 
which can form part of your CPD, 
describes what can be done to manage 

What causes MND? 

Progressive degeneration of upper or | 
lower motor neurones, or both. There are ! 
four types of MND, depending on which 
neurones are affected, and symptoms 
vary accordingly. 

When are drugs used? 

To control pain, excess saliva and dry 
mouth, and to treat spasticity, cramps 
and constipation. Riluzole is the only 
drug licensed to treat MND (but only 
"the ALS form) and slightly extends 
survival time. Breathing Space kits 
contain anticipatory medicines to deal 
with end-of-life symptoms. 

This article (Module 1521) can help in the 
following CPD competencies: Gla, Glc, 
G1d,G1v,C1a,C3d. See 

Steve Bremer MRPharmS 

Supported by 


Stephen Hawking, recently retired Lucasian 
Professor of Mathematics at Cambridge 
University, and author of A Brief History of Time, 
is perhaps the most well known person with 
motor neurone disease (MND). However, having 
survived MND for over 40 years makes professor 
Hawking a most unusual case; life expectancy for 
most people with MND is two to five years, and 
around half die within 14 months of diagnosis. 
This is a rapidly progressive disease that kills five 
people every day in the UK. 

MND is the term applied to a group of related 
diseases affecting the motor neurones in the brain 
and spinal cord. It leaves people unable to walk, 
talk or feed themselves, but the intellect and 
senses are usually unaffected. 

The disease has a varied presentation and 
unpredictable, sometimes rapid, progression. 
Onset is insidious, with early symptoms including 
stumbling, foot drop, weakened grip, slurred 
speech, cramp, muscle-wasting and tiredness. 
Some patients may present with acute respiratory 

The majority of patients are aged over 40, with 
the highest occurrence between 50 and 70, and 50 
per cent more men are affected than women. The 
incidence is around two cases per 100,000 people 
per year - similar to multiple sclerosis. But because 
of the rapid progression of MND, the prevalence is 
only about seven per 100,000, compared with 
around 50 per 100,000 for MS. The incidence of 
MND seems to be increasing slightly, although it is 
unclear whether this represents more cases or 
better diagnosis. 

The disease is characterised by progressive 
degeneration of the two types of motor neurones. 
Upper motor neurones (UMNs) run from the brain 
and down the spinal cord, where they release 
neurotransmitters across synapses to the lower 
motor neurones (LMNs), which run out of the 
spinal cord to specific muscles 

If LMNs are affected, the muscles become 
weak and floppy. A rippling effect under the skin, 
known as fasciculation, may be noticed. This is 
caused by different parts of the muscle working 
independently. If UMNs are affected, muscles 
become weak and stiff. 

There is no diagnostic test for MND, so diagnosis 
requires the demonstration of clinical signs 
affecting both the brain and spinal cord. A variety 
of neurological tests are used to exclude other 
conditions. Diagnosis is often delayed and can 
take more than 16 months from the onset of 
initial symptoms. 

There are four types of MND: 

Amyotrophic lateral sclerosis (ALS) affects 
65 per cent of patients, involving both UMN and 
LMN. About two thirds of those affected are male, 
mainly aged over 55. It is characterised by muscle 
weakness, spasticity, hyperactive reflexes, 
emotional lability, fasciculation and weight loss. 
Average survival is two to five years from onset 
of symptoms. 

Progressive bulbar palsy (PBP) is a form of 
ALS that affects 25 per cent of patients, 
predominantly women. Both UMN and LMN may 
be involved, but only supplying the head and neck. 
This form is characterised by dysarthria (unclear 
pronunciation) and dysphagia (difficulty 
swallowing). LMN damage causes nasal speech, 
regurgitation of food via the nose, tongue atrophy 
and fasciculation, and pharyngeal weakness. UMN 
damage causes spastic tongue, explosive dysarthria 
and emotional lability. Average survival is six 
months to three years from onset of symptoms. 

Progressive muscular atrophy (PMA) affects 
fewer than 10 per cent of patients, predominantly 
men, with a younger age of onset. It is mainly due 
to LMN degeneration, leading to muscle weakness 
and wasting, weight loss and fasciculation. 
Average survival is five years plus. 

Primary lateral sclerosis (PLS) affects 
around 2 per cent of patients. Men are affected 
twice as often as women and the onset is usually 
after 50 years of age. Only the UMN are damaged, 
causing muscle weakness, stiffness of limbs and 
increased reflex response. Survival is similar to 
normal life span. 

Demarcation between the clinical groups is 
often blurred. As the disease progresses there may 
be considerable overlap, resulting in more 
generalised muscle wasting and weakness. 

Most (95 per cent) of cases develop for no 
apparent reason - so-called sporadic MND. 
Genetically linked familial MND accounts for the 
remaining 5 per cent of cases, with offspring of an 
affected parent having a 50 per cent chance of 
being affected. Clinically, the two forms are 

Riluzole is the only drug licensed to treat MND. 
Nice guidance 1 recommends use of the drug only 
in patients with the ALS form of the disease. It 
provides patients with a gain in median 
tracheostomy-f ree survival time of two to four 
months. Despite strong clinical support for its use 
in other forms of the disease, riluzole is only 
licensed for ALS. 

It is thought that excessive stimulation of 
glutamate receptors on neurones plays an 



10.04.10 CPD 

Table 1 . The pharmacist's role in motor neurone disease 

Advise on medicines use in dysphagia Tablets or capsules should not be crushed or opened. 
Liquid formulations can be obtained from specials manufacturers if there is no licensed equivalent. 

Advise on drugs and enteral feeding Crushed tablets or opened capsules can block PEG feeding 
tubes. Contact the local medicines information unit or manufacturer for the most appropriate 
formulation for each drug. 

Ensure the patient is in contact with the Motor Neurone Disease Association A wide range 
of support and advice is available, from regional care advisers who will carry out home visits, to an 
equipment loan service and financial support fund. 

Supplying disability aids Patients need equipment such as bath aids, commodes, collars to 
stabilise the neck while sitting up, hand rails, wheelchairs, feeding aids, communication aids, walking 
sticks, container openers, etc. 

Brush upon the various types of enteral feeds If you have a patient with MND keep the 
relevant brand in stock. Can you deliver? 

Check medication on PMR Are symptoms such as dry mouth or constipation exacerbated by 
drug therapy? 

Breathing Space kits Are they fully stocked with in-date medicines? 

Check the local palliative care formulary Ensure relevant drugs are in stock. 

important role in the destruction of motor 
neurones in MND. Glutamate is a 
neurotransmitter that tends to excite motor 
neurone cells. Riluzole inhibits the release of 
glutamate, decreases firing of motor neurones 
induced by glutamate receptor agonists and thus 
protects cells from glutamate-mediated damage. 

Symptoms and management 


This affects 80 per cent of patients eventually. It is 
caused by weakness and wasting of the tongue, 
lips, facial muscles and pharynx and larynx. 
Progressive difficulty with articulation, slurred 
speech and loss of volume may lead to anarthria. 
Speech and language therapists can advise on 
communication strategies, while occupational 
therapists can assist with communication aids, 
seating and wrist supports. 

Between 45 and 64 per cent of patients 
experience pain at some time. It may be caused by 
muscle cramps, spasticity, stiff joints, skin 
pressure or constipation. Muscle cramps are 
treated with quinine, diazepam and baclofen. For 
spasticity, dantrolene, gabapentin, tizanidine and 
baclofen can be used. Simple analgesics are often 
ineffective, in which case NSAIDs are preferred. 
Physiotherapy can help with joint stiffness. 
Botulinum toxin may be used for spasticity and 
jaw spasm. 

Opioids are used to relieve the discomfort and 
distress of skin pressure. A laxative should always 
be prescribed concurrently. 

Oedema may be related to restricted activity 
and posture or to intercurrent disease, which 
should be treated accordingly. Support stockings 
to reduce the risk of thromboembolism are 
supplied from hospitals and not available on FP10, 
but pharmacists can advise on their care and how 
to put them on. 
Dyspnoea and choking 
Dyspnoea caused by weakened respiratory 
muscles is a common symptom in later stages but 
may occur earlier. It can cause fear, anxiety, panic 
and poor sleep. Increased C0 2 levels may cause 
headaches, particularly on waking. 

Physiotherapists and occupational therapists 
can advise on careful positioning, perhaps with the 
aid of equipment, breathing exercises and chest 

Morphine and diamorphine are used to ease 
fear, anxiety and breathlessness. Low dose beta- 
blockers such as propranolol lOmg can be used to 
reduce lung secretions, although this is an 
unlicensed indication. 

Choking attacks may be due to aspiration, 
impaired respiration or muscle spasm, or stridor 
due to acid reflux. Patients and carers can be 
reassured that death by choking is rare and that 
the final stages of MND are usually peaceful and 
dignified. The MND Association's Breathing Space 
Kit provides tangible evidence that fears have been 
addressed and practical help is at hand. The 
Association supplies kits free of charge for named 
patients at their GP's request. It contains a 
suggested list of medication, including midazolam, 
glycopyrronium bromide and diamorphine and 
advice on their use in terminal care. The GP must 
then supply a prescription for the drugs to be kept 
at home in the kit until needed. 


Dysphagia and nutrition 
Dysphagia is caused by weakness and paralysis of 
the bulbar muscles resulting from affected 
glossopharyngeal, vagus, accessory and 
hypoglossal nerves. Loss of the ability to form a 
seal with the lips, chew, propel food with the 
tongue, poor or absent swallowing reflex and 
failure to close the airway results in drooling, 
dehydration and weight loss, and aspiration and 
recurrent chest infection. 

Percutaneous endoscopic gastronomy (PEG) 
should be considered before the effort of eating 
becomes exhausting, food and fluid intake is 
inadequate, or there is danger of inspiration and 
fear of choking. 
Saliva problems 

In most patients excessive saliva is the result of 
poor lip seal and/or impaired ability to swallow. 
Medication to dry up excessive saliva, mouth 
breathing and dehydration may all contribute to 
thick tenacious saliva. 

Drooling can be limited with tricyclic 
antidepressants, atropine, hyoscine (available in 
motion sickness remedies) and glycopyrronium. 
Dry mouth can be limited with pilocarpine eye 
drops 4 per cent given orally two to three drops up 
to four times daily (an unlicensed indication) or 
artificial saliva preparations. 

If saliva is thick and tenacious, flavoured ice 
cubes, pineapple, apple or lemon juices can help. 
Mucolytics may also be used. These include 
papaya fruit, which contains an enzyme that 
breaks down the protein in tenacious saliva, 

and meat tenderiser powder, which is available 

from supermarkets. 


Sphincter muscles are not normally affected by 
MND. Altered bowel function, which requires 
laxatives, is usually the consequence of forced 
inactivity, reduced peristalsis, low fluid intake, 
reduced fibre intake or weakness of pelvic floor 
and abdominal muscles. 
Alternative options 

There is some evidence to support the use of anti- 
oxidants in MND 2 , the most popular theory being 
that motor neurones' own anti-oxidant pathways 
may not be working efficiently. Research has 
investigated the use of vitamin E, N-acetyl 
cysteine, co-enzyme Q10 and vitamin C. 

Many people with MND find that some 
complementary therapies can help make life more 
comfortable and reduce stress. Massage is one of 
the most popular, providing benefits such as 
improved muscle tone and circulation, improved 
digestion and relaxation. Acupuncture, 
aromatherapy and reflexology are also used. 
Steve Bremer MRPharmS is a freelance 
pharmaceutical writer and practising 
community pharmacist. 
References and further reading are online at 

Download a CPD log sheet that helps you 
complete your CPD entry when you 
successfully complete the 5 Minute Test for 
this Update article online (see p19). 


The management of chronic 
heart failure 

Sign up for the clinical newsletter at 


Motor neurone disease 

What are the early symptoms of motor neurone disease 
(MND)? Which motor neurones does progressive bulbar 
palsy affect? How can excessive saliva be treated? 

This article describes the different types of MND. It 
includes information about the management of 
symptoms such as dysarthria, pain, dyspnoea and 
choking, dysphagia and saliva problems, and discusses 
the role of the pharmacist 

Find out more about MND from the Patient UK 
website at 

Read the Top Tips on the MND Scotland website at, which has information 
about overcoming everyday problems and may be a 
useful resource for patients and carers. 

Read the article about MND in general practice on the 
MND Association website at 
ybrmqjp, and find out more about Breathing Space Kits 
from the same website at 

Read the information about PEG feeding tubes on the 
Patient UK website at 
and revise your knowledge of enteral feeds from 
Appendix 7 in the BNF. 

Are you now familiar with MND and its different types? 
Do you know how the symptoms are treated? Could you 
give advice to patients and carers? 

C minute test 

mJ What have you learned? 

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Signing up also ensures that C+D's weekly Update article is delivered 
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the 5 Minute Test online. 

Practical Approach 

Rules on English proficiency 

Over refreshments at a meeting of a 
local branch of the Royal 
Pharmaceutical Society, members are 
chatting about general topics. 

One says: "What do you think about 
the German doctor who came over to 
England for the weekend to do after 
hours' duties and ended up killing a 
patient with a massive overdose of 
morphine? I believe it was partly due 
to the fact that he didn't understand 
English properly. I wonder if something 
like that could happen with a 

Another answers: "I think it's 

possible. I've read in a recent survey 
that over 60 per cent of pharmacy 
employers said they don't do any 
language testing of European job 
applicants, and that 40 per cent have 
encountered problems that were 
potentially related to the language 
proficiency of employees." 

"But surely," says another, "the 
RPSGB must ensure that pharmacists 
from abroad are competent in 
English before they are allowed to 
register here? They couldn't just let 
them walk in and start practising. 
There must be some rules that would 
prevent it?" 

Another member says: "There 
certainly are strict rules for some 
overseas pharmacists, at least. I've 
got a guy working for me as a 
technician who is an experienced 
pharmacist from South Africa. But if 
he wants to work here as a 
pharmacist, he's got to go through 
an arduous and expensive re- 
qualification process. And although 
his first and only language is English, 
he's got to pass a language test." 


1. How many pharmacists from 
abroad practise in Great Britain? 

2. Is proficiency in English of 
overseas pharmacists tested 
before they can practise? 
3 What do EU pharmacists have 
to do to be registered in the UK? 
4. What do non-EU pharmacists 
have to do to be registered in 
the UK? 


1. Around 500 European pharmacists 
register each year and about 200 
pharmacists per year from outside 
the EU apply. 

2. For EU pharmacists, no. The 
2005 European Directive on the 
recognition of professional 
qualifications prevents healthcare 
regulatory bodies across Europe 
from testing the language 
competence of applicants for 
membership who have achieved 
their professional qualification 
within the European Economic Area. 
The RPSGB and other health 
professions are lobbying to get this 
changed. Pharmacists from outside 
the EU must pass an English 
proficiency examination, and to a 
high standard. 

3. They must be an EU citizen 
entitled to practise as a pharmacist 

in the EU, and in good standing 
with their national professional 
authority (ie, not currently subject 
to any disciplinary sanctions or 

4. They have to have a pharmacy 
degree that is considered to be of 
equivalent standard to a UK 
bachelor degree, be practising 
pharmacists of good standing in 
their own country and pass an 
English language test. They must 
then undertake and pass a one- 
year overseas pharmacists' course 
at a British school of pharmacy, 
followed by the same one-year 
pre-registration training 
programme as UK pharmacy 
graduates, and pass the 
registration examination. 

This article can help with these 
CPD competencies: Glh, G1m, G5f. 
See http://tiny 

Do you have an idea for a Practical 
Approach scenario or would you 
like to write one? Email us at: 


'.co.ur 19 



Following Helen Gordon's 
appointment last month 
as the first chief 
executive of the future 
professional body, Zoe 
Smeaton asks how 
pharmacy is, and talks to 
women who have worked 
their way to the top 

I alk into most community 

pharmacies and you'll likely find a 
female presence. In fact, the 
RPSCB's latest workforce census shows that in 
2008, 54 per cent of pharmacists in the 
community sector were female. And the number 
of female pharmacists on the register has been 
increasing - 64 per cent of last year's register 
entrants were female. So at first glance the 
profession seems to have more of an issue 
attracting men than women. 

But walk into a meeting of the movers and 
shakers and you might just see a different story 
unfold. Most of the key representative 
organisations, such as the National Pharmacy 
Association, the Royal Pharmaceutical Society 
(currently) and the Company Chemists' 
Association, are headed by men. And although 
there are some obvious examples of women who 
have made it to the top, in a profession dominated 
by women there certainly don't seem to be enough. 

Sandra Cidley MP, who previously worked as a 
community pharmacist, says: "I would go as far as 
to say that community pharmacy is a female 
environment dominated by male decision 
makers." The trend is repeated in the world of 
pharmacy owners, too. Sue Sharpe, PSNC chief 
executive, says although a lot of pharmacy staff 
are female, "the large majority of independent 
pharmacies are owned by men". 

But is this really a problem, or do women just 
prefer not to rise to the top of the profession? 

Certainly there are attractions to remaining an 
employee pharmacist for life. Boots and 
Lloydspharmacy both confirm that they receive 
large numbers of applications from women, and 
credit the opportunities available for women in 
pharmacy to work flexibly as one possible 
explanation. As Ms Gidley puts it: "I worked as 
a locum myself. It was a brilliant choice when I 
had young children. I could choose when and 
how much I worked and was paid reasonably 
well to boot." 

But Annette Williams, director of the UK 
Resource Centre for Women in Science, 

Jobs for the 

Engineering and Technology, says the trend could 
be having a negative impact on the profession. "As 
in any industry, if your structures inhibit any 
individual from flourishing and developing, then 
that industry is missing out on ability," she says. In 
other words, if we're not pushing women as hard 
as we could be, pharmacy is losing out on talent. 

Other industries have recognised this and are 
actively doing something about it, according to 
Christine Heading, a member of the National 
Association of Women Pharmacists' (NAWP's) 
national executive. 

In many cases, Dr Heading says, large 
companies would be carrying out research to track 
the progress of women versus that of men in their 
organisation. If women were falling behind they 
might offer specialist support, encouraging them 
to apply for the top jobs and develop themselves 
professionally. "Pharmacy just doesn't realise how 
far behind it is," she warns. 

It's not all down to the organisations, though, 
as the responsibilities that women have outside 
work could be putting them off taking those top 
positions. Ms Gidley agrees: "I regard myself as 
something of a feminist so it may surprise you to 

hear me say that - after over 50 years on this 
planet - 1 think biology has a lot to answer for... 
for many women the need to balance husband, 
family and other commitments means they can't 
be single minded about the business." 

Hesitance from women to take business risks 
and put themselves forward for the top jobs is an 
issue. Ms Williams of the UK Resource Centre says 
it may be because there aren't many women in 
these jobs at the moment, so others find it hard to 
imagine themselves doing them. "It can affect 
their aspirations," she says. 

At an institutional level this could be tackled if 
companies and pharmacy organisations 
showcased female pharmacists who had been 
successful in their careers to encourage others to 
follow. As Mrs Sharpe says: "It is good to 
showcase the pharmacists who have been 
successful, who can inspire others." 

Dr Heading says moves must also be made by 
employers, who could use strategies such as 
mentoring and monitoring progress by gender to 
identify trends, to encourage women to move up 
the career ladder. NAWP is also working hard to 
encourage employers to take on women who have 


Aim higher - check out the latest vacancies in pharmacy 


had a break from work and wish to return. And as 
Ms Cidley suggests: "Corporates should look at 
their career structures and whether the unrealistic 
burdens they can put on management level staff 
are deterring women from applying for more 
senior posts." 

Another option could be to ensure that the top 
pharmacy positions can be offered on a part-time 
basis, or with flexible hours. This might well make 
a difference given women's preference for such 
roles - they work on average more than seven 
hours less than men per week in pharmacy and 
are twice as likely to work part time 

After that, though, it will be down to women 
themselves to push ahead with their careers. 
There are many ways to do this (see box, Eight tips 
for women from others in pharmacy) and there is 
cause for optimism as women pharmacists are 
increasing in number and are younger than their 
male counterparts - the average for female 
pharmacists is 40, compared with 46 for men. 

If this trend continues, and women start to 
push their way to the top to inspire their younger 
colleagues, then perhaps in a few years pharmacy 
can catch up with colleagues in other industries. 

On being in the minority: 

"I've been at meetings where I'm the only female there and 
I have to work twice as hard and be twice as vocal to 
convince people that I'm just as capable as them. Being 
involved in the media has helped me, it means people know 
about me." 

On combining owning a business with having a family: 

"You can do it, you just need to plan and you need to get the 
support of other people." 


On whether being a woman has been difficult: 

"I am fortunate in having colleagues, both men and women, 
who concentrate on doing the job we have to do. I never really 
think about it, and I believe we have moved quite a long way 
from the days when there was an exclusive male club." 
On the advantages of being a woman in pharmacy: 
"Most pharmacy customers are women and I try hard to retain 
a focus on what they want... so from that point of view, yes, I 
think it has been useful." 

On confidence: 

"I think that women undersell themselves and I know that this 
was one of my problems previously. I see this all the time - 
good women with lots to offer will talk themselves out of 
roles rather than into them." 
On women holding back: 

"With the top jobs it is not lack of ability, but most of the top 
jobs are not 9 to 5 and, particularly if a woman has children, 
the pluses of the job would have to outweigh the negative 
effect on family and personal life." 



C+D AWARDS 10.04.10 

Awards shortlist 

C+D is delighted to announce the pharmacists, teams, assistants, technicians 
and others who have made it onto the shortlist for the C+D Awards 201 

With many of our judges saying it was "extremely difficult" to whittle the record number 
of entries down to the 69 finalists, those who made it onto the shortlist for the C+D 
Awards 2010, in association with the NPA, represent the very best of pioneering 
pharmacy practice. From a chlamydia testing university 'open day' to HPV and hepatitis vaccination, 
via robotic dispensing and store redevelopments, the breadth of achievements of our finalists 
illustrate just what's so great about community pharmacy. 

The finalists will now be invited to attend a glittering awards ceremony in London's Mayfair, where 
the winners of the 14 coveted trophies will finally be revealed. To joins us at this prestigious event, see 
Book your seat, below. Thank you to all those who submitted such high quality entries and a huge 
congratulations to those who made the shortlist - see you at the C+D Awards 2010! 

Pharmacy Team of the Year 
Sponsored by McNeil Products 

• Boots, Bon Accord, Aberdeen 

• Dean & Smedley, Ashby de-la Zouch, 

• Fishers Chemist, South Norwood, London 

• Ledbury Pharmacy, Croydon 

• Lloydspharmacy, Sway Road, Swansea 

• Midcounties Co-operative Pharmacy, 
Dursley, Gloucestershire 

• Rowlands Pharmacy, Kingston Crescent, 

Clinical Service of the Year 
Sponsored by Martindale Pharma 

• loW PCT, integrated blood screening and 
vaccination service 

• Lloydspharmacy, alcohol identification 
and brief advice service 

• Murrays Healthcare, chlamydia testing 
university 'open day', Henwick Halt, Worcester 

• NHS Westminster, HPV vaccination service 

Retailer of the Year 
Sponsored by T&R Care 

• Baskind Pharmacy, Leeds 
e Chemist Direct, London 

• Island Pharmacy, Jersey 
" Paydens 

• Rowlands Pharmacy 

• Thackers Pharmacy, Wythenshawe, Lancashire 

Pharmacy Assistant of the Year 
Sponsored by P&G PharmacyCare 

• Jennifer Hutchison, Sainsburys Pharmacy, 
Ballymena, County Antrim 

• Hazel McConnell, Boots, Omagh, County Tyrone 

• Patricia McCaig, Boots, Glasgow 

• Doreen Walker, Boots, Bolton 

Pharmacy Business Leader of the Year 

Sponsored by Actavis 

• Jay Badenhorst, Whitworth Chemists 

• Kenny Black, Rowlands Pharmacy 

• Michael Holden, Hampshire & loW LPC 

• John Nuttall, The Co-operative Pharmacy 

• Graham Phillips, Manor Pharmacy Group, 

Business Development of the Year 

Sponsored by GlaxoSmithKline 
Consumer Healthcare 

• Brittania Pharmacy, polyclinic LPS contract, 
llford, Essex 

• Gill Pharmacy, store redevelopment, 
Southall, Middlesex 

• Hodgson Pharmacy, online store and service 
development, Longfield, Kent 

• Lloydspharmacy, out patient services, Royal 
Liverpool & Broadgreen University Hospitals 
NHS Trust 

• Mr Pickford's Pharmacy, store redevelopment, 

What last year's 
winners say 

"It's really nice to 
get recognition. It's 
a big boost to your 
confidence and a 
real motivator" 

Valerie Sillito, C+D Prescriber of the Year 
2009 and C+D Community Pharmacist of 
the Year 2008 

"There have been 
lots of new 
opportunities from 
the interest that the 
Award created, 
which has given me 
the platform to take 
things forward in a 
number of 

Michael Maguire, C+D Community 
Pharmacist of the Year 2009 

"If you've got a 
higher profile it's 
going to improve the 
interest in your 

Duncan Murray, Murrays Healthcare, 
C+D Pharmacy Team of the Year 2009 

"A really excellent 
batch of applications" 
"Very inspiring, I have 
to say" 


fi^flc ijour seat for the event of the year 

14 trophies • 1 unmissable night 
Wednesday, June 9 • Grosvenor House Hotel, Park Lane, London 


Book your seat at the event of the year 

10.04.10 C+D AWARDS 

"Some interesting and promising examples of pharmacy 
innovation in professional practice" judge, c+d awards 2010 

Pharmacist Prescriber of the Year 
Sponsored by PLUS from GlaxoSmithKline 

• Lucia Castagnetti, The Co-operative Pharmacy, 
Crossgates, Leeds 

• Colin Dougall, Lloydspharmacy, 
Drumchapel, Glasgow 

• Kaushik Patel, Jaywick Pharmacy, 
Clacton-on-Sea, Essex 

• Nader Siabi, Pharma Healthcare, 
Hornchurch, Essex 

Pre-registration Graduate of the Year 
Sponsored by Reckitt Benckiser Healthcare 

• Ajith Adai, Chemistree Pharmacy, 
Watford, Herts 

• Sarah Buchan, Rowlands Pharmacy, Dalgety 
Bay, Fife 

• Jenna Kirley, The Co-operative Pharmacy, 
Fauldhouse, West Lothian 

• Sharon Lindsay, Boots, St Enoch Square, 

• Nupur Shah, Leyton Orient Pharmacy, 
Leyton, London 

• Mark Smith, Lloydspharmacy, Wishaw, Glasgow 

Community Pharmacist of the Year 

Sponsored by Teva UK 

• Rachna Chhatralia, Day Lewis, 
Roundshaw-Wallington, Surrey 

• Taseen Iqbal, Modi Pharmacy, Dudley, 
West Midlands 

• Kevin McDevitt, Crossin Chemist, Belfast 

• Graham Phillips, Manor Pharmacy Group, 

Pharmacy Innovation of the Year 
Sponsored by Ceuta Healthcare 

• Doncaster LPC, local quality and outcomes 
framework (QOF) 

• Lime Tree Pharmacy,, Worthing, 
West Sussex 

• Lloydspharmacy, Online Doctor Service 

• NHS Westminster, HPV vaccination service 

• Pinnacle Health Partnership, healthcare 
solutions through limited liability partnership, 
Ventnor, loW 

• Will Chemists, robotic dispensing, Inverurie, 

New Pharmacist of the Year 

Sponsored by AAH Pharmaceuticals 

• Waqas Ahmad, Neils Pharmacy, 
Prescot, Merseyside 

• Taseen Iqbal, Modi Pharmacy, Dudley, 
West Midlands 

• Elen Jones, The Co-operative Pharmacy, Gilfach 
Goch, Mid Glamorgan 

• Ravi Vaitha, Kamsons Pharmacy, Crawley, 
West Sussex 

Pharmacy Manager of the Year 
Sponsored by Sigma Pharmaceuticals 

• Taseen Iqbal, Modi Pharmacy, 
Dudley, West Midlands 

• Bhavesh Patel, Pharma Healthcare, Canvey 
Island, Essex 

• Zoe Emily Pearce, Sainsburys Pharmacy, 
Chippenham, Wiltshire 

• Elaine Stevenson, Manor Pharmacy 
(Medipharmacy), Wallington, Surrey 

Pharmacy Technician of the Year 

• Sally Atmore, Paydens Pharmacy, 
Aylesford, Kent 

• Sally Clarke, The Co-operative Pharmacy, 
Aspley, Nottinghamshire 

• Laura Jones, Fishers Chemist, South Norwood, 

• Hicham Makboul, Nashi Pharmacy, Westbourne 
Grove, London 

• Julie Morran, Rowlands Pharmacy, Walsall, West 

• Gemma Sharpies, Lloydspharmacy, Bolton 

MUR Champion of the Year 

• Keith Howell, Delmergate Pharmacy, 
Heme Bay, Kent 

• Perry Melnick, Manor Pharmacy, Letchworth, 

• Patricia Ojo, Day Lewis, Bromley, Kent 

• SamiahTambra, Midcounties Co-operative 
Pharmacy, Walsall, West Midlands 

Sponsored by 

Martindale Pharma 8 




Consumer Healthcare 

PLUS f-< 





i5™r?"'i»\fi/?Pt f "f ( OMP4 V/ 


Book now to avoid disappointment 

Book online at 
or telephone: 0207 921 8359 23 



maximising OTC sales 

Jennifer Richardson hears your new merchandising mantra from 

Reckitt Benckiser's Trevor Gore 

You may think you know how to sell OTC medicines and, as far as the 
basics go, you'd probably be right. "The fundamentals of over the 
counter selling have not changed," says Reckitt Benckiser sales 
development controller Trevor Gore. So that's the four Ps - product, 
place, price and promotion. But many pharmacists could do with a 
refresher course in what these things actually mean - and, more 

importantly, how you should apply them to your pharmacy - Mr Core 
believes. Not only that, but he's added three more Ps into the equation 
PCTs, public expectation and people. Get these seven Ps right, he says, 
and you'll see a boost to your business in terms of both footfall and 
OTC sales. "If you merchandise correctly you don't lose people walking 
past," Mr Gore says. 

First, you must ensure signpost brands are visible in all 
categories. "People do react better to brands and they get 
more [for example] pain relief. It doesn't make sense to us as 
scientists, but it does to the public," Mr Gore says. 

And this visibility is important even to those customers who 
aren't brand-focused, he adds, explaining: "Mothers may not 
buy Calpol, but they need to see Calpol to know they're in the 
right place." As well as these leading brands, stock new 
products with media awareness, as customers may come in and 
ask for them, and ensure key pharmacy medicines with unique 
benefits over GSL products are available. 

And don't try to do it all. "Pharmacies like to try to stock 
everything - but you can't stock everything," Mr Gore says. 
Check your EPoS or sales data regularly to work out what sells, 
he advises - and be ruthless. "The public finds it easier to shop 
when you have fewer products and less clutter," Mr Gore says, 
giving the example that there are more than 60 adult pain 
relief products - but just 25 of these make up 80 per cent of 
pharmacy sales in the market. 

Focus on stocking the basics in different pack sizes, he 
suggests, adding that if you need to stock a product for a 
particular loyal customer that is not popular with others, there 
is no need to have it out on display - keep it in a drawer. 

"Put the best product in the best place on the shelf," Mr Gore 
says. "Don't leave it to chance - as in, 'We'll put these there just 
because it fits'." He points to data that shows that on a five- 
shelf unit, the biggest proportion of sales is from the middle 
shelf, closely followed by the second from top; the bottom shelf 
has the lowest proportion of sales. Moving a product from the 
bottom to second from top shelf increases sales by 78 per cent; 
the reverse relocation decreases sales by 40 per cent. 

Of course price is important - but it's not community 
pharmacy's USP (unique selling point), says Mr Gore, so don't 
give it undue weight in your merchandising mindset. "If you're 
just going to sell boxes for money, somebody can do it better 
than you and for less money," Mr Gore says. "We have got to 
get out of the mindset that [selling medicines] is just a cash 

He explains: "It's about adding value not price - it's about 
understanding the difference between them." And it's the 
customer who decides what good value means to them. Mr 
Gore gives the example of diamonds versus water - their 
relative value is very much dependent on your perspective and 
situation. Imagine trekking through the desert for two days 
without the latter, and you'll see what he means. 

The two biggest launches for pharmacy last year, Mr Gore 

points out, were Alii and Optrex ActiMist, both in double figure 
prices at over £30 for the smallest pack and almost £15 
respectively. "If [the customers] want them, they'll spend 
whatever it takes." All this means you shouldn't be afraid to upsell, 
he adds, such as by offering different formats or related products. 

Promotions can play a role in customers' purchasing decisions, 
says Mr Gore, but make sure you know why you are offering 
them. Take time to analyse what is the most effective for your 
pharmacy and your customers; is it a certain percentage off the 
usual price, BOGOF (buy one, get one free), or BOGSHP (buy 
one, get second half price), for example? 


The area where pharmacy "can prove its worth", according to 
Mr Gore, is in advice for minor ailments. The sector has long 
been lobbying for a national minor ailments scheme, but for 
now any such service is in local commissioners' hands. Talk to 
local GPs to get them on side, Mr Gore advises - in a Royal 
College of GPs survey, 86 per cent wanted immediate action to 
change the culture of dependency on GPs for minor ailments. 

Public expectation 

Advice is what the public expects of community pharmacies, Mr 
Gore says, and you should offer it with every sale you make. He 
remembers, with a shudder, 2008's Which? investigation, which 
found "unsatisfactory" advice with a third of pharmacy sales. 
"Eight per cent of independent pharmacies didn't ask any 
questions when selling medicines - that's a disgrace," he says. 

He also issues a plea for pharmacists and pharmacy staff to 
remember to ask open questions. "Do something that makes 
you different from a hole in the wall or a vending machine." 

And advice is where your staff come in, Mr Gore says: "Your 
staff are your biggest asset." A simple way to motivate them is 
to keep them informed. "I'm always amazed that pharmacy 
assistants haven't been told what the new contract is, what 
PNAs are," Mr Gore says. "How can you expect your number 
one asset to be involved in helping you do what you're going to 
do if you haven't told them what the game is?" 

And one more thing... 

Perhaps we should add another P to pharmacies' merchandising 
mantra - presentation. Mr Gore notes with exasperation: "Sometimes 
the only thing I can be sure some shops sell are dead wasps - because 
their windows are full of them." Trevor Gore was speaking at the 
Sigma Conference in China in February 



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JOBS 10.04.10 


Browse jobs, upload your CV and get careers advice the NPA 
The NPA has launched an 
undergraduate training programme 
designed to provide employers with 
a structured course for pharmacy 
students working in pharmacies 
during the summer holiday or as 
part-time or weekend employees, 
ahead of their pre-registration year. 

In two parts, the programme has a 
suggested timetable that can be 
tailored to the length of time a 
student will be working, and includes 
MCQs and case studies. 

"This interactive and structured 
training programme allows the 
undergraduate to gain new 
knowledge and to implement the 
knowledge acquired at university," 
said NPA assistant head of education 
and training Sabina Khanom. "The 
programme is an ideal platform 
for moving onto the provision of 
pre-reg training." 

The course costs £125 plus VAT. 
For more information, contact NPA 
Education and Training on 01727 
800402 or training. 

The NPA is also offering free 
media training this summer. The 
day-long course is designed to help 
members develop skills for speaking 
to both broadcast and print media. 
Run by "expert media professionals", 
it will be held on June 3 in Belfast 
and on June 6 in London. To attend, 

... at the MHRA 

Three pharmacists have been 

appointed to a pair of independent 

advisory bodies for medicines 

advertising and medicinal products 


Medicines regulator the MHRA 
and the independent Appointments 
Commission have announced 13 
appointments to the Independent 
Review Panel for Advertising and the 
Independent Review Panel for 
Borderline Products, which are 
served by the same panel of experts. 

The seven four-year appointments 
include former GlaxoSmithKline 
Healthcare director of regulatory, 
medical and consumer affairs 
Elizabeth Bamford, and consultant in 
pharmaceutical development Brian 
Whittle. The six two-yeai 
appointments included Norgine 
Pharmaceuticals' interim medical 
affairs manager David Kettle. 

Got a burning careers question? 
and we'll ask the experts 

Religion at work 

As ethical objections to providing contraception services hit the 
headlines again, Chris Chapman unravels the rules 

Religion in the workplace is 
a sensitive issue, but one 
that's vital for pharmacists 
to understand. According to the 
2001 census, three quarters of the 
population believe in a higher 
power. Around seven in 10 are 
Christian, 2.7 per cent Muslim, 1 per 
cent Hindu and 0.6 per cent Sikh. 
It's therefore likely that the majority 
of a pharmacy's staff are religious - 
and they have rights. 

And it's something pharmacy 
employers recognise. Boots says it 
tries to accommodate religious 
beliefs "where practicable", but says 
it has to balance the needs of 
employees with providing a high 
standard of customer care. 

Religion in the workplace is 
governed by Employment Equality 
regulations, which protect 
employees against discrimination on 
the basis of race, gender, sexual 
orientation, age and religion. 

Religion is only loosely defined, 
and it is up to an individual court to 
decide what counts. While the 
regulations are primarily to prevent 
harassment and ensure equal 
opportunities, they can impact on all 
areas of work, from dress code to 
break times. But perhaps the most 
important for pharmacy is the right 
of employees to opt out of delivering 
a service because of their beliefs. 

Pharmacists have the legal right 
to refuse to provide a service, such 
as emergency hormonal 
contraception, because of religious 
or ethical beliefs. According to the 
RPSGB Code of Ethics, it is up to 
individual pharmacists whether they 
decline to offer a particular service. If 
they do decline, the code says they 
must ensure "the relevant persons or 
authorities are informed, and patients 
referred to alternative providers". 
The General Pharmaceutical 

Legislation may protect against religious discrimination, but is it always practical? 

Council, taking over regulation of 
pharmacy this year, has confirmed 
this 'conscience clause' will 
continue. However, additional 
requirements, such as displaying 
signs informing customers of the 
clause, may be required. 

Pharmacists shouldn't try to 
dissuade a person from the service 
on religious or ethical grounds. "Any 
attempt by a pharmacist to impose 
their beliefs on a member of the 
public seeking professional guidance, 
or failure to have systems in place to 
advise of alternative sources for the 
service required, would be of great 
concern to the RPSGB," says a 
Society spokeswoman 

Another area of contention is 
dress code. For example, the Sikh 
Federation points out that Sikh 
employees have the right to wear 
articles of faith at work under the 
Race Relations Act, including the 
kirpan, a ceremonial dagger. 

The religious dress of Muslims 
varies, the Muslim Council of Great 
Britain (MCGB) says. It recommends 
employers ensure any dress code can 
accommodate requirements to 
prevent indirect discrimination. 

The MCGB recommends the dress 

code for women should allow the 
whole body to be covered except the 
face and hands. For men, the body 
needs to be covered from navel to 
the knees, and employees should be 
allowed to grow a beard. 

According to a spokesperson for 
Boots, it is best to work closely with 
employees to ensure any attire 
meets the company's brand values. 

Employers do not have to give 
employees time off for prayers, and 
can expect them to pray in their 
break. However, the MCGB warns 
that it could amount to indirect 
discrimination if an employer can 
make allowances but refuses, or if 
other employees are allowed to take 
additional smoking breaks. 

Employers do not have to grant 
requests to move lunch breaks or 
give time to Muslims to break their 
fast during Ramadan, but would 
need to justify refusing a request 
because of a legitimate business 
need that cannot be met otherwise. 

Employers do not have to make 
costly adjustments to provide prayer 
space, but if it is possible to provide 
a room without an adverse impact 
on the business, it could be 
construed as discrimination to refuse. 

Career tip of the week 

"A prepared interviewee will always research the company before attending for 
interview, irrespective of how interesting the company seems. Remember the 
motto: prior preparation prevents a poor performance!" 

From Brilliant job hunting, by Angela Fagan 





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Springboard: sign up n@w 
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!i:iraiiNjiiiiui!;;4 |pu ^gramme 

Springboard is a pre-registration programme offered by 
Medway School of Pharmacy in partnership with C+D. 
Springboard equips pre-registration students with the skills 
and confidence to ensure a smooth transition from pharmacy 
graduate to practicing pharmacist. 

The Springboard pre-registration training programme consists 
of eight study days facilitated and delivered by staff from C+D 
and Medway School of Pharmacy covering a wide variety of 
topics, enabling students to meet the appropriate competencies 
in the RPSCB's student handbook. 

Springboard is unique in that by the end of the course the 
students will have also completed an accredited medicines 
use review training programme, the C+D Counterpart 
pharmacy assistant course, the Practice Certificate in Pharmacy 
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Got a story for Postscript? 

Online with C+D 

Talking points 

"How about pharmacists even finding time 
to spend five minutes with a customer 
without worrying about the backlog this 
will create over the course of the day" 

I Amp on the Avicenna survey of independent 
contractors. Posted on C+D online. 

The top stories last week 

1. 'Murky double life' leads to three-year 
jail term 

2. Update module 1519: Managing patients 
on warfarin 

3. Managing codeine concerns 

4. £1k for pricing errors 

5. MBE pharmacist Charles Butler jailed for 
fraud and drug stash at bondage flat 

To post a comment, simply register at 

Hair today 

Postscript doesn't often get a letter, so when one 
landed on our desk begging for assistance, we 
were eager to help. The only problem is, we don't 
know the answer. 

"Dear sirs," the letter, from Newcastle, began. 
"At 90 years of age I haven't much hair left to 
dress these days, but over the years I regularly 
used Brilliantine in my youth, and more recently 
Vaseline hair tonic." 

Umm, right. The writer adds that he doesn't like 
modern hair gel, and asks where he could get "the 
good old liquid (oil)" to slap on his barnet. 

Postscript's approach to thatch is pretty much 
"get it cut short enough that you don't have to 
comb it for a few months", so we don't know But 
pharmacists are a helpful sort. Do you know 
where our Geordie geriatric can get a squirt or two 
of hair oil? There's a prize in it for you if you do. 

C+D Reader of the week 

t chipmunk-keeping Hampshire pharmacist Sid Dajani, and find 
hat horrible present a customer opened on his counter 

If you have a bacon sandwich, do you have it 

with ketchup or brown sauce? Both, but I am 

addicted to Reggae Reggae sauce 

What's the best holiday you've ever been 

©n? The Seychelles, because of the scenery and 
the diving. As an epicure I love its exquisite 
edibles and interesting potables. 

What's your greatest achievement? My father 
moved in after his stroke left him paralysed, with 
dysphagia, depression and anorexia. Being a 
surgeon he made the worst patient. Through hard 
work, resilience, laughter, tears and encouragement 
he has his life back and manages our olive farms 
in Jordan. My sisters and I are so proud of him, 
his greatest achievement is ours too. 

What's the strangest request you've had in 

your pharmacy? Either inserting a suppository 
into an overweight lady who couldn't do it 
herself, or having a dirty nappy opened on the 
counter and asked if the baby had worms. 

What's the best thing on TV at the moment? 
Absolutely no idea - the OFF button? 

Where is your dream place to live? 
Hampshire, where I'm surrounded by wildlife, 
countryside and there are lots of places for dog 
walks. And I can keep my wolves, peacocks, 
chipmunks, chickens and geese in harmony! 

Did you belong to any clubs or societies at 
university? Loads where there was a party, fun 
and laughter to be had! The Chinese, Asian, 
Welsh Societies, BPSA, YPC, the Halcyon Society 
and the Students Union. And I was a member of 
the University of London Union until I became 
the first to be banned since 1965! 

What should we ask the next interviewee? If 

you were a superhero, who would you be? 

Calling all pharmacists and technicians. We 
want you to be our reader of the week. Email 
us at 

• HH : 

@The Web Hunter 

The government and the Department of Health 
(DH) seem to spend an awful lot of time and 
money trying to change the way bad things are 
advertised: think about cigarettes, alcohol and 
junk food. But in their presumed wisdom, I think 
they might be overlooking common sense. 

I mean, is it just me, or is anyone else fed up 
with reading headlines that say, "Study finds that 
being fat is unhealthy" or DH ad campaigns telling 
us to drink less and exercise more? I know the 
powers that be are trying to do the right thing, but 
part of me thinks that the £100 million spent on 
the government's Campaign for Smarter Drinking 
could have been better spent elsewhere. 

And what of the pharmacy PR campaign? How 
much of the estimated £26m spent by the DH on 
TV ads and the further £25m on radio and print 
will be siphoned off to promote pharmacy, and 
how should it be spent? 

It seems the Labour government is not that keen 
on it being spent locally. "Far from ideal," as PSNC 
head of NHS services Alastair Buxton described it. 
The Tories, on the other hand, are keen on the 
local idea (according to Mark Simmonds when we 
met him last month). They have also promised to 
cut the marketing budget of the DH. 

So while I'm keen on the idea of fewer big ads 
telling me that to get rid of my spare tyre I should 
eat more salads and fewer bacon sandwiches, will 
fewer ads telling me about local pharmacy 
services really work? 

I don't know. But let's hope they apply some 
common sense. 

Niall Hunt is C+D's digital content editor; 
email him at 

A social tweet 

From evil laughs to snoring, join the debate at chemistdruggist 

@Squeelaa: @CandDChris seems to be practising 
evil laughs. Mwoa ha ha ha haaa. 

@CandDChris: @Squeelaa I'm an evil mastermind. 
That's why I wear a cape in the office and keep 
minions and henchpersons about to fetch cake 
and sweeties. 

@Squeelaa: Proving his evilness @CandDChris has 
just hacked an icing Bunny up with a knife. Mwoa 
ha ha ha ha harrrrrgh. 

@GaryParagpuri: The man sitting opposite me on 
the train is snoring loudly while appearing to be 
wide awake. Fascinating. 


Springboard x 

Springboard Pre-registration Training Programme 2010-11 

Springboard is an exciting pre-registration training programme, offered in 
partnership by C+D and Medway School of Pharmacy. 
Springboard covers all aspects of the community pharmacy experience and 
assists the trainee in making a smooth transition from student to professional. 

The programme consists of eight in-house study days covering: 

Responding to symptoms 
Law and Ethics 
Controlled Drug regulations 
Medicines use reviews 
Drug Tariff 

Pharmaceutical calculations 
Dressings and wound management 
Monitored dose units 
Smoking cessation 

Drug misuse 
Communication skills 
First aid 

The NHS and how it works 
Influencing your PCT 
Auditing your services 
Clinical cases using the BNF 
Practice exam questions 

The programme enables the student to meet the appropriate competences in the RPSGB 
pre-registration student handbook, and offers support to pre-reg tutors via a tutor training day 
and throughout the year. Students are allocated a nominated personal tutor in addition to their 
pre-reg tutor in the workplace. 

This programme is unique in that the students have the opportunity to be accredited to 
provide medicines use reviews. Additionally students are able to accumulate credits by 
completing distance learning courses included in the programme that can be put towards 
a postgraduate qualification. 

All eight student study days and the tutor day will be held at a central London location. 

For more information on the Springboard course, complete the slip below and return to: 
Kinna McConochie, 8th Floor, Ludgate House, 245 Blackfriars Road, London SE1 9UY; 
Alternatively, call Kinna on 0207 921 8413 or email 

LJ YES, please send me more information on the Springboard pre-registration training programme 






in association with 

Medway School of Pharmacy 

University of 



UBM Medica would like to keep you up to date about our products 
and services for healthcare professionals Our emails may also include 
information from other carefully selected companies including 
promotional materials from pharmaceutical companies that may be of 
interest to you Your details WILL NOT be passed on to third parties 
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Benadryl Allergy Relief Product Information: 
Presentation: Acrivastine 8 mg capsules. Uses: Allergic 
rhinitis. Also chronic idiopathic urticaria Dosage: Adults 
and children aged 12-65 years: one capsule up to 
3 times a day. Contraindications: Hypersensitivity to 
acrivastine or triprolidine. Significant renal impairment. 
Precautions: Caution when engaging in activities which 
require mental alertness until familiar with response 
to drug. Concomitant use of acrivastine with alcohol 
or other CNS depressants may produce additional 
impairment. Caution when taking with ketoconazole, 
erythromycin or grapefruit juice. Pregnancy & 
lactation: Not recommended. Side effects: Rarely 
drowsiness. RRP (ex -VAT): 12s £4.35, 24s £7.55 
Legal category: 12s GSL, 24s P. PL holder: McNeil 
Products Ltd, Foundation Park, Maidenhead, Berks, SL6 
3UG. PL no: 1 2s 1 551 3/01 28, 24s 1 551 3/0035. Date 
of prep: April 2008 


Benadryl Plus Capsules Product Information: 
Presentation: Acrivastine 8mg and pseudoephedrine 
60mg capsules. Uses: Symptomatic relief of allergic 
rhinitis. Dosage: Adults and children 12-65 years: 
One capsule as necessary, up to three times a day. 
Contraindications: Hypersensitivity or intolerance to any 
of the ingredients or triprolidine. Severe hypertension, 
severe heart disease or significant renal impairment; 
patients who have taken MAOI's in the preceding 14 
days. Concomitant use with furazolidone. Precautions: 
Diabetes, hyperthyroidism, heart disease, hypertension, 
glaucoma or prostatic enlargement. Advise patients not to 
undertake tasks requiring mental alertness whilst under 
the influence of alcohol or other CNS depressants. Effects 
of alcohol or other CNS depressants may be enhanced. 
Patients taking sympathomimetics, antihypertensives, 
and tricyclic antidepressants Pregnancy & lactation: 
Not recommended Side effects: Rarely drowsiness, 

CNS excitement; occasionally skin rash, or urinary 
retention in men. RRP (ex-VAT): 12s £4.99 Legal 
category: P PL holder: McNeil Products Ltd, Foundation 
Park, Maidenhead, Berks, SL6 3UG. PL no: 1 551 3/001 7 
Date of prep: April 2008 


1 . Nielsen L et at Allergy 1 994; 49; 630-6. 

2. Benadryl Allergy Relief SmPC (www.emc.medicines. 

3. Brogden RN, McTavish D. Drugs 1991 ; 41(6); 

4 Slater JW, Zechnich AD, Haxby DG. Drugs 1999; 57(1)' 

5. Martindale: The Complete Drug Reference. 36th Ed 

Piriton* is a registered trade mark 
of the GlaxoSmithKline group 

of companies McNeil )